Perioperative use of β-blocker in noncardiac surgery: A multicenter educational intervention to achieve best practice guidelines

Perioperative cardiac ischemia and infarction are important causes of morbidity and mortality in patients undergoing noncardiac surgery. There is now significant evidence that the use of prophylactic β-adrenergic antagonists among selected patients at risk for perioperative cardiovascular complications is associated with a reduction in myocardial ischemia and cardiac events. Furthermore, consensus guidelines have incorporated the findings of recent studies and provide recommendations for the appropriate utilization of β-adrenergic antagonists among selected patients. Despite these guidelines, it is unknown to what extent these recommendations have become translated into clinical practice. After measuring perioperative β-blocker use among participating hospitals within the New York Presbyterian Health Network, we developed a multicenter educational intervention to improve the overall utilization of β-adrenergic prophylactic therapy in accordance with best practice guidelines. The literature supporting the development of this intervention is presented in this paper, along with the tools that are currently being used for decision support across an academic healthcare network.